Compacta thickness, implant design and implant site preparation have a strong impact on the primary stability of mini-implants for orthodontic anchorage. Depending on the insertion site and local bone quality, the clinician should choose an optimum combination of implant and pilot-drilling diameter and depth.

The diameter and design of the mini-implant thread have a distinctive impact on primary stability. Depending on the region of insertion and local bone quality, the choice of the mini-implant design and size is crucial to establish sufficient primary stability.

BackgroundProtraction facemask has been advocated for treatment of class III malocclusion with maxillary deficiency. Studies using tooth-borne rapid palatal expansion (RPE) appliance as anchorage have experienced side effects such as forward movement of the maxillary molars, excessive proclination of the maxillary incisors, and an increase in lower face height. A new Hybrid Hyrax bone-anchored RPE appliance claimed to minimize the side effects of maxillary expansion and protraction. A retrospective study was conducted to compare the skeletal and dentoalveolar changes in patients treated with these two protocols.MethodsTwenty class III patients (8 males, 12 females, mean age 9.8 ± 1.6 years) who were treated consecutively with the tooth-borne maxillary RPE and protraction device were compared with 20 class III patients (8 males, 12 females, mean age 9.6 ± 1.2 years) who were treated consecutively with the bone-anchored maxillary RPE and protraction appliances. Lateral cephalograms were taken at the start of treatment and at the end of maxillary protraction. A control group of class III patients with no treatment was included to subtract changes due to growth to obtain the true appliance effect. A custom cephalometric analysis based on measurements described by Bjork and Pancherz, McNamara, Tweed, and Steiner analyses was used to determine skeletal and dental changes. Data were analyzed using a one-way analysis of variance.ResultsSignificant differences between the two groups were found in 8 out of 29 cephalometric variables (p < .05). Subjects in the tooth-borne facemask group had more proclination of maxillary incisors (OLp-Is, Is-SNL), increase in overjet correction, and correction in molar relationship. Subjects in the bone-anchored facemask group had less downward movement of the “A” point, less opening of the mandibular plane (SNL-ML and FH-ML), and more vertical eruption of the maxillary incisors.ConclusionsThe Hybrid Hyrax bone-anchored RPE appliance minimized the side effect encounter by tooth-borne RPE appliance for maxillary expansion and protraction and may serve as an alternative treatment appliance for correcting class III patients with a hyperdivergent growth pattern.

Objective:To analyze the impact of the insertion angle on the primary stability of mini-implants. Materials and Methods: A total of 28 ilium bone segments of pigs were embedded in resin. Two different mini-implant sizes (Dual-Top Screw 1.6 ϫ 8 mm and 2.0 ϫ 10 mm) were inserted at seven different angles (30Њ, 40Њ, 50Њ, 60Њ, 70Њ, 80Њ, and 90Њ). The insertion torque was recorded to assess primary stability. In each bone, five Dual-Top Screws were used to compensate for differences in local bone quality. Results: The angle of mini-implant insertion had a significant impact on primary stability. The highest insertion torque values were measured at angles between 60Њ and 70Њ (63.8Њ for DualTop 1.6 mm and 66.7Њ for Dual-Top 2.0 mm). Very oblique insertion angles (30Њ) resulted in reduced primary stability. Conclusions: To achieve the best primary stability, an insertion angle ranging from 60Њ to 70Њ is advisable. If the available space between two adjacent roots is small, a more oblique direction of insertion seems to be favorable to minimize the risk of root contact.

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Root contact can be recognized during pre-drilling by a distinct increase in resistance, and during mini-implant insertion by higher torques.

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The objective of this article was to illustrate the digital process in the custom fabrication of metallic mini-implant supported appliances. An implant-supported appliance was produced for a patient using a CAD-CAM procedure without a physical impression or a printed model. The work flow consisted of mini-implant insertion into the palate, recording an intraoral digital scan, digital design with incorporation of a scanned expansion mechanism, direct 3-dimensional metal printing via laser melting, laser welding of the hyrax mechanism, insertion, and activation of the appliance. The favorable clinical outcome demonstrated that this procedure is an efficient and viable method for constructing an implant-supported palatal metallic appliance.